Thoracic Syrinx in a patient with balance difficulties

The patient was a 42-year-old woman who was referred to a physical therapist with diagnoses of lumbar degenerative joint disease and a left ankle fracture. The patient reported an insidious onset of low back and left lower extremity pain, which began approximately 2 years prior to referral. She reported having difficulties with balance, which ultimately led to a fall 1 year after her low back and left lower extremity pain began. Her fall resulted in a left ankle fracture that required open reduction and internal fixation. Magnetic resonance imaging of her brain and spine revealed a diffuse, abnormally increased cord signal. The patient was diagnosed with a thoracic syrinx, which is a longitudinal fluid-filled cavity along the spinal cord. The patient underwent a T5-T6 hemilaminectomy, with placement of a syringopleural shunt between T4 and T6. Following surgery, the patient's neurologic status stabilized and did not deteriorate any further.